Travel Health Alert Notices and Haiti cholera outbreak, Florida, USA, 2011.

To enhance the timeliness of medical evaluation for cholera-like illness during the 2011 cholera outbreak in Hispaniola, printed Travel Health Alert Notices (T-HANs) were distributed to travelers from Haiti to the United States. Evaluation of the T-HANs' influence on travelers' health care­seeking behavior suggested T-HANs might positively influence health care­seeking behavior.

Surveillance of completed suicide in the Department of the Navy.

In 1999, the Department of the Navy (DoN) began a suicide surveillance program using the DoN Suicide Incident Report (DONSIR) to collect data on completed suicides in the Navy and Marine Corps. The DONSIR significantly advances the capability of DoN to track and analyze data on completed suicides over time. The long-term goal of this program is to improve suicide prevention by identifying and modifying military-specific risk factors. A DONSIR has been completed on 98% of the 200 DoN suicides that occurred from 1999 to 2001. Most DoN suicides occurred outside the military work environment and involved the use of a firearm. Most decedents were men, had experienced a recent relationship problem, and did not use any military support services in the 30 days before suicide. Results suggest that the promotion of support services may improve the effectiveness of DoN suicide prevention.

Management and control of varicella on cruise ships: a collaborative approach to promoting public health.

BACKGROUND: In most years varicella is the vaccine-preventable disease most frequently reported to Centers for Disease Control and Prevention (CDC) by cruise ships. Since 2005, CDC has received numerous isolated case reports of varicella among crew members and has investigated varicella outbreaks aboard vessels sailing into and from US seaports. METHODS: CDC investigators reviewed electronic varicella case reports from 2005 to 2009 and outbreak reports from 2009 to characterize the response and control efforts implemented by cruise ships in accordance with CDC protocols. Outbreak reports from 2009 were manually reviewed for details of case identification, contact investigations, isolation and restriction of cases and contacts, respectively, and number of contacts administered varicella vaccine post-exposure by cruise lines. RESULTS: During 2005 to 2009, cruise ships reported 278 cases of varicella to CDC among predominantly male (80%) crew members, three-quarters of whom were residents of Caribbean countries, Indonesia, the Philippines, or India, and whose median age was 29 years. Cases were more commonly reported during spring and winter months. During 2009, cruise ships reported 94 varicella cases among crew members of which 66 (70%) were associated with 18 reported varicella outbreaks. Outbreak response included isolation of 66 (100%) of 66 cases, restriction of 66 (26%) of 255 crew-contacts, and administration of post-exposure vaccine to 522 close contacts and other susceptible crew members per standard CDC recommendations. DISCUSSION: Most cases reported to CDC during 2005 to 2009 were among non-US resident crew members. Overall, cruise lines sailing into North America have the onboard capability to manage varicella cases and outbreaks and appear responsive to CDC recommendations. Cruise lines should continue to implement CDC-recommended response protocols to curtail outbreaks rapidly and should consider whether pre-placement varicella immunity screening and vaccination of crew members is a cost-effective option for their respective fleet operations.